Pharmacist Immunizers: Implementing the Adult Immunization Standard

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1 Pharmacist Immunizers: Implementing the Adult Immunization Standard Jeff Goad, Pharm.D., MPH Professor and Chair, Department of Pharmacy Practice Chapman University School of Pharmacy

2 Pharmacists are Health Care Providers in CA! 4050(c): pharmacists are health care providers who have the authority to provide health care services

3 New Pharmacy Immunization Law Independent (B&P4052.8) Initiate and/or administer 3 years and older Routine vaccines ACIP recommended, published by CDC

4 What Vaccines are Not Routinely Recommended by ACIP? Typhoid Yellow Fever Japanese Encephalitis Rabies BCG Travel Vaccines Can still do under protocol

5 Pharmacy Immunization Law (new and old) Initiate and/or administer Training An approved immunization training program - Endorsed by CDC or ACPE - Injection technique, indications/cis, emergency mgmt. Maintain IZ training 1 hr of CE q2 yrs BLS - maintain May initiate/admin Epi or diphenhydramine BOP finalized August 26, 2016

6 IZ Law Documentation Vaccine administration record Pharmacy readily retrievable Patient record ( yellow card ) Notification of vaccination PCP and/or Pre-natal provider Immunization registry (IIS) All within 14 days of administration

7 Documentation Screening VAR Consent 7

8 PPCP created by the Joint Commission of Pharmacy Practitioners in 2014 Developed to promote consistency in how patient care is taught and practiced Adapted for immunization practice in 2016 at Chapman University Consistent with NVAC and CDC Standards for Adult Immunization Practice Assess Recommend Administer Document

9 The PPCP Joint Commission of Pharmacy Practitioners. Pharmacists Patient Care Process. May 29, 2014.

10 Collect The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical history and clinical status of the patient. Information may be gathered and verified from multiple sources, including existing patient records, the patient, and other healthcare professionals. This process includes collecting: Demographics Immunization records A current medication list Relevant health data Patient lifestyle habits, preferences, beliefs, health and functional goals, and socioeconomic factors

11 Sources of Information Immunization Information Systems (IIS) Personal Immunization Record Pharmacy Dispensing System Primary Care Providers (PCP) Patient-Provided History

12 Assess The pharmacist assesses the information collected and analyzes the need for vaccines according to the FDA and ACIP. This process includes assessing: Age Current and past health conditions, medications e.g. level of immunecompetence Pregnancy status Lifestyle Occupation Travel Current health status Allergies Vaccination history

13 Plan Patient specific PCP collaboration Determine education needs Dispel myths Minimize financial barriers State scope of practice Make strong vaccine recommendations Integrate motivational interviewing

14 Access is not always enough

15 Proactive Vaccination Reactive vaccination: patients ask for a vaccine Proactive vaccination: pharmacist identifies patients in need of a vaccine Use Collect and Assess steps to identify patients Use Strong Recommendations and Motivational Interviewing to persuade people to get vaccinated

16 What vaccine providers say really does matter Provider communication and HPV vaccination: The impact of recommendation quality Shingles vaccine receipt in 60+ pharmacy population Gilkey MB et al. Vaccine (9): Strong endorsement Teeter BS et al. Vaccine. 2014; 32(43): Prevention message + = High- Quality Rec Urgency

17 Which statement sounds the most persuasive? Pneumococcal vaccine is recommended at age 65; do you want it? You might want to consider getting the pneumococcal vaccine I'm giving you the pneumococcal vaccine today because it is recommended at age 65 I strongly recommend that you receive the pneumococcal vaccine today because it can protect you from diseases caused by pneumococcal bacteria, including pneumonia. These diseases could be very serious for you now that you are older

18 Implement The pharmacist implements the care plan in collaboration with other health care professionals, as needed, and the patient or caregiver. During the process of implementing the care plan, the pharmacist: Consider state law Administer vaccines Consider workflow and space Supplies and storage Documentation VAR, screening form, consent, IZ record, PMS record, provider communication Coordination of care Referrals Communication with other providers Joint Commission of Pharmacy Practitioners. Pharmacists Patient Care Process. May 29, 2014.

19 Follow-Up: Monitor and Evaluate The pharmacist should have systems in place and training for appropriate monitoring and management of possible adverse reactions. This process includes the continuous monitoring and evaluation of: Having a written emergency plan Stocking epinephrine and diphenhydramine Report to VAERS and VERP Establish a system for boosters and completion of series